Updated 5:21 pm, Friday, September 22, 2017

FILE — In this July 27, 2017, file photo, Sen. John McCain, R-Ariz., speaks to reporters on Capitol Hill in Washington. McCain says he won’t vote for the Republican bill repealing the Obama health care law. His statement likely deals a fatal blow to the last-gasp GOP measure in a Senate showdown expected next week. less

FILE — In this July 27, 2017, file photo, Sen. John McCain, R-Ariz., speaks to reporters on Capitol Hill in Washington. McCain says he won’t vote for the Republican bill repealing the Obama health care law. … more

Photo: Cliff Owen, AP

FILE– Sen. John McCain leaves the the Senate chamber at the U.S. Capitol on July 28, 2017 in Washington, DC. McCain of Arizona dealt a major and possibly lethal blow to the Republican Party’s latest attempt to replace the Affordable Care Act on Friday, saying he “could not in good conscience” vote for because the partisan process that created it would “leave the American people guessing from one election to the next whether and how they will acquire health insurance.” less

FILE– Sen. John McCain leaves the the Senate chamber at the U.S. Capitol on July 28, 2017 in Washington, DC. McCain of Arizona dealt a major and possibly lethal blow to the Republican Party’s latest attempt … more

Photo: Justin Sullivan

Sen. Susan Collins, R-Maine, speaks with reporters before heading into a policy luncheon on Capitol Hill, Tuesday, Sept. 19, 2017 in Washington. Collins said Friday she is considering also voting no on the bill. less

Sen. Susan Collins, R-Maine, speaks with reporters before heading into a policy luncheon on Capitol Hill, Tuesday, Sept. 19, 2017 in Washington. Collins said Friday she is considering also voting no on the … more

Photo: Alex Brandon, AP

Senator Rand Paul, a Republican from Kentucky, right, and Senator Bob Corker, a Republican from Tennessee, stand next to seats before the start of a lunch with U.S. President Donald Trump, not pictured, and members of Congress at the State Dining Room of the White House in Washington, D.C., U.S., on Wednesday, July 19, 2017. Sen. John McCain of Arizona dealt a major and possibly lethal blow to the Republican Party’s latest attempt to replace the Affordable Care Act on Friday, saying he “could not in good conscience” vote for because the partisan process that created it would “leave the American people guessing from one election to the next whether and how they will acquire health insurance.” less

Senator Rand Paul, a Republican from Kentucky, right, and Senator Bob Corker, a Republican from Tennessee, stand next to seats before the start of a lunch with U.S. President Donald Trump, not pictured, and … more

Photo: Michael Reynolds

Sen. John McCain speaks to reporters Monday, days before announcing his opposition to his party’s health care bill.

Sen. John McCain speaks to reporters Monday, days before announcing his opposition to his party’s health care bill.

Photo: TOM BRENNER, NYT

FILE – In this July 27, 2017, file photo, Sen. John McCain, R-Ariz., speaks to reporters on Capitol Hill in Washington. McCain says he won’t vote for the Republican bill repealing the Obama health care law. His statement likely deals a fatal blow to the last-gasp GOP measure in a Senate showdown expected next week. (AP Photo/Cliff Owen, file) less

FILE – In this July 27, 2017, file photo, Sen. John McCain, R-Ariz., speaks to reporters on Capitol Hill in Washington. McCain says he won’t vote for the Republican bill repealing the Obama health care law. … more

Photo: Cliff Owen, Associated Press

Sen. John McCain (R-Ariz.) talks to reporters on Capitol Hill, in Washington, Sept. 18, 2017. Just when the effort to repeal the Affordable Care Act appeared to be dead, a last-ditch push to obliterate the law could be nearing a showdown vote in the Senate, and a handful of Republicans insist they are closing in on the votes. (Tom Brenner/The New York Times) less

Sen. John McCain (R-Ariz.) talks to reporters on Capitol Hill, in Washington, Sept. 18, 2017. Just when the effort to repeal the Affordable Care Act appeared to be dead, a last-ditch push to obliterate the law … more

Photo: TOM BRENNER, NYT

Sen. McCain deals another blow to GOP efforts on health care

WASHINGTON — A last-ditch effort by Senate Republicans to fulfill a seven-year campaign promise to replace the Affordable Care Act appeared to be on life-support Friday after Sen. John McCain said he would vote against the bill.

With a full bloc of Senate Democrats opposing the health care overhaul, the bill’s sponsors can afford to lose only two Republicans to avoid defeat. Sen. Rand Paul, R-Ky., has also declared his opposition, and a third, Susan Collins, R-Maine, said Friday she was leaning that way.

McCain announced his decision in a statement in which he said he “could not in good conscience” support the bill because the partisan process that created it would “leave the American people guessing from one election to the next whether and how they will acquire health insurance.”

Senate Republicans, who hold a slim 52-48 majority, are pushing for a vote by Friday, when special rules that would allow the bill, co-sponsored by Sens. Lindsey Graham, R-S.C. and Bill Cassidy, R-La., to pass with a bare 50 votes plus a tie-breaking vote by Vice President Mike Pence. After Friday, 60 votes would be required for passage.

One hearing is scheduled with the Senate Finance Committee for Monday afternoon, and the nonpartisan Congressional Budget Office, Congress’ official arbiter of major legislation, has said it cannot complete analysis of the impact of the proposal on health-insurance coverage and premiums by Friday’s deadline.

As in July, when McCain cast the dramatic vote that killed the last Republican effort to repeal the current health law, the Arizona Republican lamented a legislative process devoid of committee hearings and a Congressional Budget Office review.

“I believe we could do better working together, Republicans and Democrats, and have not yet really tried,” McCain said. “Nor could I support it without knowing how much it will cost, how it will affect insurance premiums, and how many people will be helped or hurt by it.”

McCain acknowledged that his move probably torpedoes the bill co-sponsored by Graham, his closest friend in the Senate.

“The bill’s authors are my dearest friends, and I think the world of them,” McCain said. But he blasted the process his party used to move legislation that he said would affect “a fifth of our economy and every single American family.”

Graham said his friendship with McCain is not based on how he votes but on “how he’s lived his life and the person he is,” and said he would “press on” with his bill.

There was no immediate reaction from President Trump. But Pence said the fight wasn’t over.

“This is not going to be easy. Some have gone so far as to announce their opposition already,” he said. “President Trump and I are undeterred.”

A defeat of the Graham-Cassidy bill, if it happens, would be a huge break for California, which vigorously embraced the Affordable Care Act, using its federal funds to expand coverage to 5 million people, and would be among the hardest hit by its repeal. By some estimates, the state stands to lose $78 billion in federal funds from 2020 to 2026 alone under the legislation.

House Minority Leader Nancy Pelosi, D-San Francisco, praised McCain for “once again” showing courage on behalf of the public, and urged House Speaker Paul Ryan, R-Wis., to begin bipartisan talks in the House to fix some of the widely acknowledged problems in the Affordable Care Act that have kept premiums high, especially for small businesses and individuals buying policies on its state exchanges.

Such negotiations had been started in the Senate Health, Education, Labor and Pensions Committee between its chairman, Lamar Alexander, R-Tenn., and ranking Democrat Patty Murray of Washington, after the July repeal effort failed, but Senate Majority Leader Mitch McConnell, R-Ky., killed those talks when he announced that he would bring the Graham-Cassidy bill to a vote next week.

Murray also applauded McCain.

“I agree with Sen. McCain that the right way to get things done in the Senate — especially on an issue as important to families as their health care — is through regular order and working together to find common ground,” she said. She added that she is confident “that we can reach a bipartisan agreement as soon as this latest partisan approach by Republican leaders is finally set aside.”

Senate Minority Leader Chuck Schumer, D-N.Y., said he “assured Sen. McCain that as soon as repeal is off the table, we Democrats are intent on resuming the bipartisan process.”

Republicans have faced broad opposition to their repeal bills from nearly every corner of the health care industry, which grew louder and more unified with each legislative iteration. On Friday, California-based Kaiser Permanente and its unions came out strongly against Graham-Cassidy, joining the nation’s biggest names among insurers, doctor and hospital groups and patient advocacy organizations.

McCain’s announcement came on the same day that Collins, who joined McCain in voting against the Republican repeal effort in July, said she is “leaning against” the current bill, especially because it, in effect, would void the current law’s requirement that insurers issue policies to people with chronic medical conditions such as cancer or diabetes. An estimated 100 million people have what is known as a pre-existing condition.

Under the Graham-Cassidy plan, states would be required to set up their own health-insurance systems, with far less federal money than they get now, and would have the flexibility to radically alter the current law’s rules.

Collins said that while the bill ostensibly requires insurers to cover people with pre-existing conditions, it could allow insurers to charge them premiums that she said would “be so high they would be unaffordable.”

Another blow to the GOP effort came Friday from Alaska’s Department of Health and Social Services, which said the state would lose 65 percent of its funding under the repeal bill, going further than previous GOP repeal efforts.

Sen. Lisa Murkowski, R-Alaska, also voted against the July repeal effort but has not stated her position on the latest version, and had said its effect on her state would play a big role in her decision.